Coronary artery calcium scoring: an evidence-based guide for primary care physicians

B. Y.C. Cheong, J. M. Wilson, S. J. Spann, R. I. Pettigrew, O. A. Preventza, R. Muthupillai

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations


Primary care physicians often must decide whether statin therapy would be appropriate (in addition to lifestyle modification) for managing asymptomatic individuals with borderline or intermediate risk for developing atherosclerotic cardiovascular disease (ASCVD), as assessed on the basis of traditional risk factors. In appropriate subjects, a simple, noninvasive measurement of coronary artery calcium can help clarify risk. Coronary atherosclerosis is a chronic inflammatory disease, with atherosclerotic plaque formation involving intimal inflammation and repeated cycles of erosion and fibrosis, healing and calcification. Atherosclerotic plaque formation represents the prognostic link between risk factors and future clinical events. The presence of coronary artery calcification is almost exclusively an indication of coronary artery disease, except in certain metabolic conditions. Coronary artery calcification can be detected and quantified in a matter of seconds by noncontrast electrocardiogram-gated low-dose X-ray computed tomography (coronary artery calcium scoring [CACS]). Since the publication of the seminal work by Dr. Arthur Agatston in 1990, a wealth of CACS-based prognostic data has been reported. In addition, recent guidelines from various professional societies conclude that CACS may be considered as a tool for reclassifying risk for atherosclerotic cardiovascular disease in patients otherwise assessed to have intermediate risk, so as to more accurately inform decisions about possible statin therapy in addition to lifestyle modification as primary preventive therapy. In this review, we provide an overview of CACS, from acquisition to interpretation, and summarize the scientific evidence for and the appropriate use of CACS as put forth in current clinical guidelines.

Original languageEnglish (US)
Pages (from-to)309-324
Number of pages16
JournalJournal of Internal Medicine
Issue number3
StatePublished - Mar 2021


  • coronary artery disease
  • coronary atherosclerosis
  • multidetector computed tomography
  • risk assessment
  • risk reduction behaviour
  • Risk Assessment
  • Humans
  • Risk Factors
  • Tomography, X-Ray Computed
  • Evidence-Based Medicine
  • Coronary Artery Disease/diagnostic imaging
  • Coronary Angiography
  • Vascular Calcification/diagnostic imaging
  • Primary Health Care
  • Practice Guidelines as Topic

ASJC Scopus subject areas

  • Internal Medicine


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